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Community-Driven Tuberculosis Interventions for Aboriginal Communities Community-Driven Tuberculosis Interventions for Aboriginal Communities

Community-Driven Tuberculosis Interventions for Aboriginal Communities - PowerPoint Presentation

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Community-Driven Tuberculosis Interventions for Aboriginal Communities - PPT Presentation

Jessica Harper amp Nash Dhalla February 19 2015 Hyatt Regency Vancouver Conflict of Interest Neither presenter Nash Dhalla RN BScN or Jessica Harper RN BScN have any affiliation financial or otherwise with a commercial or other industry interest that may bias our presenta ID: 780461

tbsac igra communities bccdc igra tbsac bccdc communities tst ltbi testing test nurse community health services amp nations harper

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Presentation Transcript

Slide1

Community-Driven Tuberculosis Interventions for Aboriginal Communities

Jessica Harper & Nash DhallaFebruary 19, 2015Hyatt Regency Vancouver

Slide2

Conflict of Interest:

Neither presenter (Nash Dhalla, RN, BScN or Jessica Harper, RN, BScN) have any affiliation financial or otherwise, with a commercial or other industry interest that may bias our presentation.

Slide3

Outline

TBSAC: Who we areWhat is TB?TST vs IGRAFeasibility of Portable Incubator in LTBI testing

Challenges

Next Steps

Slide4

TB Services in BC

Centralized: pharmacy, labs, database, physician consultant, and nurse consultant services provided by TB Services, BC Centre for Disease ControlTB Services for Aboriginal Communities (TBSAC): provides TB services to Health Centers located on-reserve, funded and delivered in partnership with First Nations Health Authority (FNHA).4

Slide5

TB Services

Community Health NurseCommunity Health WorkerDOT WorkersHealth DirectorsCommunity Members

CDC Coordinator-TB, Funding, Education, Resources

Physician Consultation

Nurse

Consultation

Case Management

Pharmacy, Lab, Diagnostics, X-Ray, Surveillance, Training and Education

Slide6

TB Team

BCCDC (TBSAC)Dr. Victoria Cook, TBSAC PhysicianShawna Buchholz, Clinical Nurse EducatorNash Dhalla, Nurse ConsultantKaren Beinhaker

, Nurse ConsultantFNHA, Health ProtectionJessica Harper, CDC Coordinator, TB

6

Slide7

Background: What is TB?Mycobacterium tuberculosisAirborne disease

Generally infects the lungsIn BC: incidence rate of ~7 per 100 000Symptoms: coughing, fever, weight loss, night sweatsCurable and Preventable!

Slide8

Background: What is LTBI?“Sleeping” Latent TB infection (LTBI):

Infected with bacteria? YESSymptoms present? NOInfectious? NOA healthy individual infected with LTBI has a 5-10% risk of developing active TB over their lifetime

(BCCDC TB Control Manual, 2012)

Slide9

Background: Diagnosing & Treating LTBI

Tuberculin Skin Test (TST) is an intradermal injection of 0.1ml of purified protein derived from M.Tuberculosis bacteriaFollow up Chest X-ray to check for active TB

Slide10

Background: Diagnosing & Treating LTBI

Recommended for preventative therapy:Isoniazid for 9 months –270 doses ORRifampin for 4 months –120 dosesDecision to start treatment is based on:Context of TST – likelihood of false positiveReason client was being testedRisk of progression to active disease

Ability to adhere to medicationPossible intolerance to medicationAlcohol use, desire for pregnancy, etc.

(BCCDC TB Control Manual,

2012

)

Slide11

The IGRA TestInterferon Gamma Release Assay (IGRA)Detects interferon gamma released from WBC

Two tests: Quantiferon Gold and T-SpotBC: offered in Vancouver, New Westminster, Victoria, Prince George and Kelowna

Slide12

IGRA vs. TST

(TB Manual: Interferon Gamma Release Assay Testing Guideline for Diagnosis of Latent Tuberculosis Infection by Physicians, 2013, pg. 2)

Slide13

TST vs. IGRA

TST

IGRA

Good for serial testing

Not as good for serial testing

Inexpensive

More expensive

Universally accessible

Skill,

equipment

and

timeframe needed limit accessibility

Low specificity in certain

populations

(BCG-60%)

High specificity in all populations

Two visits

One visit

Variability in test interpretation by reader

*****

Low variability in test interpretation by reader

Slide14

WHY IGRA?

To identify the proportion of patients in whom treatment for LTBI could be avoided because an IGRA test was negative yet a TST test was positive.To determine if there is a statistically significant difference in treatment adherence between BC residents who have had LTBI confirmed with an IGRA test and those whose diagnoses was made using a TST only.

Slide15

IGRA Feasibility In First Nations Communities Currently IGRA is offered at the BCCDC, in New Westminster, Victoria, Kelowna and Prince George

Increase access to testing for patients who are less likely/able to travel for testing:Remote communities Outbreak investigationEnhanced communities Identify and treat true LTBIAre communities interested in the IGRA test?

Slide16

IGRA testing: Feasibility TBSAC Team & Community Leaders discussed IGRA

Based on enhanced community surveyStrong links with HCPGeographic location IGRA available in Canada 2007 with strong evidence baseBCG FactorCommunity engagement

Slide17

Results: Feasibility TestCommunity approval

Meet with BCCDC lab to agree on expectations of how samples are deliveredDevelop detailed protocol on sample collection, processing and transportation to labConfirm site visit date(s)Conduct site visit & feasibility testDetermine resultsSummarizing resultsLessons learned

Slide18

Vision of the FNHAIn partnership with BC First Nations Communities the FNHA TBSAC program is working towards the Vision of:

“Healthy, Self-determining and Vibrant BC First Nations Children, Families and Communities.”

Slide19

Acknowledgements BCCDC- Zoonotic Lab

Yvonne SimpsonMuhammad MorshedQuantine WongFNHA and TBSAC teamApril MacNaugtonDr. Isaac SobolDr. Victoria Cook Jane LopezMaggie Wong Shawna Buchholz

Karen Beinhaker

First Nations Communities

Healthcare Professionals

Community members

Community leaders

Thank You!

Slide20

Contact Information

TBSAC Nurses: Nash Dhalla: (604)707-2695Nash.dhalla@bccdc.caKaren Beinhaker: (604)707-2732karen.beinhaker@bccdc.ca

Shawna Buchholz: (250)878-4928Shawna.buchholz@bccdc.ca

FNHA Nurse:

Jessica Harper: (604)693-6955

jessica.harper@fnha.ca

TBSAC Fax:

(604)707-2690

TBSAC Toll Free:

1-888-569-2299

FNHA Health Protection Toll Free:

1-844-364-2232

20

Slide21

Thank You!